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Reflexology in the management of encopresis and chronic constipation
Abstract
Encopresis or faecal incontinence in children is an extremely distressing condition that is usually secondary to chronic constipation/stool withholding. Traditional management with enemas may add to the child's distress. This study investigated the efficacy of treating patients with encopresis and chronic constipation with reflexology. An observational study was carried out of 50 children between three and 14 years of age who had a diagnosis of encopresis/chronic constipation. The children received six sessions of 30-minutes of reflexology to their feet. With the help of their parents they completed questionnaires on bowel motions and soiling patterns before, during and after the treatment. A further questionnaire was completed by parents pre and post treatment on their attitude towards reflexology. Forty-eight of the children completed the sessions. The number of bowel motions increased and the incidence of soiling decreased. Parents were keen to try the reflexology and were satisfied with the effect of reflexology on their child's condition. It appears that reflexology has been an effective method of treating encopresis and constipation over a six-week period in this cohort of patients.
... [19][20][21][22] Reflexology, which is an ancient healing art, 6 a holistic noninvasive pressure 19 and a touch therapy, 23 is a system of massage based on the principles that there are reflex points on the feet, hands, and ears, which correspond to every part, organ, and gland of the body. 6,19,22,[24][25][26] All approaches to reflexology develop very specific maps of the feet, hands, or ears showing these connections. 22 When a gentle pressure is applied to a particular zone of the feet, hands, or ears, it influences the corresponding zone in the body. ...
... 19,23,27 It is also suggested that reflexology stimulates the release of endorphins, the body's painkilling chemical. 27 Reflexology facilitates homeostasis 24 and relaxes the body, mind, and spirit 19 ; it is effective in helping to diminish a variety of adverse symptoms such as stress, fatigue, pain, and tension 23 and helps with anxiety and depression. 6 ...
... Researchers have examined the effectiveness of reflexology in improving the perceived health and well-being of patients with irritable bowel syndrome, 7 in relieving migraine and tension headache, 21 in improvement of sleep quality in patients with insomnia, 30 in treating encopresis and constipation in children, 24 in reducing anxiety in hospitalized patients with cancer in chemotherapy treatment, 31 in decreasing anxiety in patients undergoing coronary artery bypass graft surgery, 20 in evaluating the effect of reflexology on mood and symptom rating of patients with advanced cancer, 32 in reduction in observed pain in nursing home residents, 33 in decreasing pain intensity and anxiety in patients with metastatic cancer, 33 in investigating the effect of foot reflexology on general fatigue, foot fatigue, mood, and blood glucose levels in non-insulin-dependent patients, 34 and in a symptomatic treatment for breast cancer. 34,35 In recent studies, reflexology has been described as an important treatment method in reducing anxiety, agitation, and pain, providing relaxation and comfort, and increasing sleep quality. ...
The aim of this study was to investigate the effect of reflexology on pain intensity in patients with fibromyalgia, using an experimental repeated-measures design, and a convenience sample of 30 fibromyalgia inpatients. Thirty patients aged 18 to 70 years with fibromyalgia and hospitalized in the algology clinic were taken as a convenience sample. Patients received a total of 12 60-minute sessions of reflexology over a period of 6 consecutive weeks. Reflexology was carried out bilaterally on the hands and feet of patients at the reflex points relating to their pain at a suitable intensity and angle. Subjects had pain scores taken immediately before the intervention (0 minute), and at the 60th minute of the intervention. Data were collected over a 10-month period in 2012. The patients' mean pain intensity scores were reduced by reflexology, and this decrease improved progressively in the first and sixth weeks of the intervention, indicating a cumulative dose effect. The results of this study implied that the inclusion of reflexology in the routine care of patients with fibromyalgia could provide nurses with an effective practice for reducing pain intensity in these patients.
... [22][23][24][25] Reflexology, which is an ancient healing art, 26 a holistic noninvasive pressure, 23 and a touch therapy, 27 is system of massage based on the principles that there are reflex points on the feet, hands, and ears that correspond to every part, organ, and gland of the body. 23,25,26,[28][29][30] All approaches to reflexology develop very specific maps of the feet, hands, or ears showing these connections. 25 When a gentle pressure is applied to a particular zone of the feet, hands, or ears, it influences the corresponding zone in the body. ...
... 23,31,32 It is also suggested that reflexology stimulates the release of endorphins-the body's painkilling chemical. 31 Reflexology facilitates homeostasis 28 and relaxes the body, mind, and spirit 23 ; it is effective in helping to diminish a variety of adverse symptoms such as stress, fatigue, pain, and tension 27 and helps with anxiety and depression. 26 Modern-day reflexology is based on techniques developed by Eunice Ingham, a physiotherapist. ...
... 26 Several reflexology sessions will normally be suggested for maximum benefit. 25 Researchers have examined the effectiveness of reflexology in improving the perceived health and well-being of patients with irritable bowel syndrome 35 ; in relieving migraine and tension headache 22 ; in improvement of sleep quality in patients with insomnia 36 ; in treating encopresis and constipation in children 28 ; in reducing anxiety in hospitalized patients with cancer in chemotherapy treatment 37 ; in decreasing anxiety in patients undergoing coronary artery bypass graft surgery 24 ; in evaluating the effect of reflexology on mood and symptom rating of patients with advanced cancer 38 ; in reduction in observed pain in nursing home residents 39 ; in decreasing pain intensity and anxiety in patients with metastatic cancer 40 ; in investigating the effect of foot reflexology on general fatigue, foot fatigue, mood, and blood glucose levels in non-insulin-dependent patients 41 ; and in a symptomatic treatment of breast cancer. 41,42 In the recent studies, reflexology has been described as an important treatment method in reducing anxiety and agitation, providing relaxation and comfort, and increasing the sleep quality. ...
To investigate whether reflexology has an effect on the physiological signs of anxiety and level of sedation in patients receiving mechanically ventilated support, a single blinded, randomized controlled design with repeated measures was used in the intensive care unit of a university hospital in Turkey. Patients (n = 60) aged between 18 and 70 years and were hospitalized in the intensive care unit and receiving mechanically ventilated support. Participants were randomized to a control group or an intervention group. The latter received 30 minutes of reflexology therapy on their feet, hands, and ears for 5 days. Subjects had vital signs taken immediately before the intervention and at the 10th, 20th, and 30th minutes of the intervention. In the collection of the data, "American Association of Critical-Care Nurses Sedation Assessment Scale" was used. The reflexology therapy group had a significantly lower heart rate, systolic blood pressure, diastolic blood pressure, and respiratory rate than the control group. A statistically significant difference was found between the averages of the scores that the patients included in the experimental and control groups received from the agitation, anxiety, sleep, and patient-ventilator synchrony subscales of the American Association of Critical-Care Nurses Sedation Assessment Scale. Reflexology can serve as an effective method of decreasing the physiological signs of anxiety and the required level of sedation in patients receiving mechanically ventilated support. Nurses who have appropriate training and certification may include reflexology in routine care to reduce the physiological signs of anxiety of patients receiving mechanical ventilation.
... Some of the complementary approaches like acupuncture [9], reflexology [10], treatment movement [11], massage therapy [12] and herbal therapy [13]are suggested effective in the relief of constipation. While researchers such as Bishop et al. [14] suggest positive effects of reflexology in the treatment of chronic constipation and bowel incontinence, few such studies have been completed in this field and the evidence supporting its use is limited. A similar pattern is evident for the use of abdominal massage, Sinclair et al. [15] for example have suggested its use in patients experiencing constipation arguing that it is inexpensive, it is easily applied, it is noninvasive , it has no known side effects, it is time saving for nurses and it is applicable by the patients themselves. ...
... The difference between two intervention groups was not significant statistically. The present study showed constipation severity decreased after foot reflexology to a level that is compatible with Bishop et al.[14], In that study reflexology was administered for 6 sessions and the use of foot massage there showed to be a significant treatment for chronic constipation. ...
Constipation is one of the most common health problems presenting in patients hospitalized within orthopedic settings. This present study was done with the aim of determining the effect of foot reflexology and abdominal massage on constipation severity. This study is a single -blind randomized controlled trial completed using 3 groups comprising a total of 60 patients hospitalized in the orthopedic wards of shohada hospital in the Northwest Azerbaijan- Iran. One of the intervention groups involved the use of foot reflexology and in the other abdominal massage was carried out once daily for 6 days. An assessor blinded to the group allocation measured and recorded constipation severity before the intervention, then daily from day 1 until day 6 post intervention by constipation evaluation scale. For data analysis, ANOVA, ANCOVA and repeated measurement ANOVA tests was used in SPSS version 16. There was no significant difference between the intervention and control groups in constipation severity over the first two days (p>0. 05) built from the 3rd until the 6th days after the intervention, the difference was
significant (p0.05). After modification and deleting covariate variables, again, there was a significant difference between intervention groups with a control group from day 3 until day 6 of the intervention(p
... Foot reflexology was shown to be effective in treating fecal incontinence and chronic constipation in 50 children aged 3 to 14 years who participated in an observational study. The majority of the children improved without experiencing any side effects, and 72% of the parents expressed high satisfaction with the children's treatment [4]. In 2010, a study found that foot massage effectively reduced postoperative pain intensity in Turkish pregnant women, in contrast to a control observation group, indicating its potential in pain management [5]. ...
In this article, we review a recently published article to explore the significance of foot reflexology in modern medical practice. With the advancement of modern medicine, we are increasingly committed to finding the specific physiological mechanisms of foot reflexes to treat diseases, thereby better proving the therapy’s effectiveness. It has been reported that foot reflexes can activate the cerebral cortex and organs corresponding to the feet, stimulating blood flow, nutrition and nerves through neural and endocrine regulation to achieve the purpose of treating and preventing diseases and promoting health. The therapy shows unique potential and value, and provides a new perspective on integrating traditional medicine and modern medicine.
... Improvement included stool frequency, consistency, and straining. These findings are congruent with those of Bishop (2003), who examined the effect of "reflexology in the management of www.iiste.org Therefore, the current study proved that foot reflexology has positive effects on autism symptoms and constipation in children with the autistic spectrum disorder. ...
The autistic Spectrum Disorder represents specific distinguishable symptoms that have frequent concurrent conditions and constipation is the most frequent. It requires an effective non-disturbing management. Reflexology is a widely used technique and documented as a useful nursing intervention. This study aimed to determine the effect of foot reflexology on autism symptoms and constipation in children with ASD. Subject and Methods: a quasi-experimental design was utilized and it conducted at the psychiatric outpatient clinic, Menoufia University hospital. A purposive sample of 40 children was recruited. Two instruments were used: Autism Treatment Evaluation Checklist (ATEC) and Constipation Assessment Questionnaire (CAQ). Results: children had lower mean scores and severity of autism symptoms on post-intervention compared to pre-intervention speech/communication, sociability, sensory/cognitive, health/physical/behavior subdomains and the total ATEC score. The mean total score of constipation symptoms was lower on post-intervention compared to pre-intervention (35.93±16.04, 40.23±17.51 respectively) and there was a significant correlation (R=0.858) at the 0.01 level of significance between constipation and the severity of autism symptoms on post-intervention. Conclusion: the study concluded that autistic children exposed to feet reflexology experienced lower mean scores of autism symptoms and less severity of constipation compared to pre reflexology massage. There was a significant correlation between constipation and the severity of autism symptoms on post-intervention. Recommendation: Feet reflexology should be integrated as a part of routine daily care for autistic children; courses that enable nurses to obtain a certification in reflexology are needed.
... 15,16 Today, reflexology applications which are applied to reduce/ prevent nausea, vomiting and sleep problems in cancer patients are noteworthy. [17][18][19] Reflexology is "a technique that helps the normalization of body functions by a hand application to the reflex points on the hands, feet and ears associated with all of the glands, organs and body parts." In addition, reflexology is a "special pressure technique and energy balancing system". ...
... This improvement and pain relief is caused by increased blood flow and encephalin release through pituitary gland stimulation [11]. Bishop et al. found that 50 children underwent 30 minutes of reflexology during 6 sessions and increased intestinal function [24]. Woodward et al. applied reflexology to 19 women for 6 weeks and reported that the defecation frequency increased and constipation decreased after the treatment [25]. ...
... these studies are relatively small scale; further research should be done to compare the impact of therapist (professional and lay) versus therapy, for example. In contrast, the study of Bishop et al. found foot reflexol- ogy to be an effective method of treating encopresis and constipation ( Bishop, McKinnon, Weir, & Brown, 2003 ). Further larger studies should be performed due to these contradictory results. ...
Functional constipation is a common problem in Turkey that affects up to 10% of children. Reflexologists claim that reflexology can be beneficial in the treatment of constipation. The aim of this randomized controlled study was to determine the effectiveness of reflexology in treating functional constipation in children. Thirty-seven children who were referred to a pediatrician with functional constipation as defined by the Rome III criteria were recruited to the study. After the physician's diagnosis, two groups (intervention/control) were created. The intervention and control groups comprised 17 and 20 children, respectively. Each child in the intervention group was given a foot massage for 10 minutes five times a week, and toilet/diet/motivation training was given to their parents. The test period lasted for 4 weeks. Toilet/diet/motivation training was undertaken for 30 minutes once per week (for a total of 4 weeks) in an interactive manner. The parents of children in the control group received equivalent toilet/diet/motivation training only. No significant differences in terms of feces frequency and feces consistency were noted between the intervention and control groups (p >.05). This study sample showed that only toilet/diet/motivation training had potential benefit for treating functional constipation in children. Further larger randomized trials are required to establish whether there are benefits to foot message in the treatment of functional constipation in children.
... Grealish et al. [29] have shown the effect of foot massage and reflexology on decreasing the anxiety, pain and nausea in patients with cancer. Bishop et al. [4] have proved that reflexology is an effective method of treating encopresis and constipation patients. Christ Stormer has clearly explained the healing effect of reflexology on respiratory, circulatory, and cardiac disorders. ...
Analysis of heart rate variation (HRV) has become a popular non-invasive tool for assessing the activities of the autonomic nervous system (ANS). HRV analysis is based on the concept that fast fluctuations may specifically reflect changes of sympathetic and vagal activity. It shows that the structure generating the signal is not simply linear, but also involves non-linear contributions. These signals are essentially non-stationary and may contain indicators of cardiac health. This work is an attempt made to do a quantitative study on the effect of reflexology on the heart rate variability (HRV) during reflexologic stimulation. The non-linear parameters are evaluated for this study and the results obtained for 20 subjects are tabulated. Résumé L'analyse de la variation de fréquence cardiaque (HRV) est devenue un outil non invasif très répandu pour évaluer les activités du système nerveux autonome. L'intérêt de la HRV réside dans le fait que les fluctuations rapides peuvent spécifiquement refléter des changements d'activité des systèmes sympathique et vagal. Elle prouve que la structure produisant du signal n'est pas simplement linéaire et met en jeu des fonctionnements non-linéaires. Les signaux sont essentiellement non stationnaires et peuvent refléter des dysfonctionnements cardiaques. Ce travail tente de faire une étude quantitative de l'effet des stimulations réflexologiques sur la variabilité de la HRV. Les paramètres non linéaires sont évalués dans cette étude et les résultats obtenus pour 20 sujets sont présentés.
... Other treatment approaches that have been reported in the literature with varying results include biofeedback, hypnosis, reflexology, and Internet-based educational programs,14,22–25 even if with results that are inconclusive. ...
According to the Rome III criteria, encopresis without constipation was defined as nonretentive fecal soiling (FNRFS) with not yet well understood etiology. Treatment approaches reported in the literature with varying results include biofeedback, hypnosis, reflexology, and Internet-based educational programs. In developmental age, another behavioral treatment could be identified in the psychomotor approach, which is called psychomotricity in the European countries, or is also known as play therapy. The aim of the present study was to verify the safety and efficacy of play therapy plus toilet training in a small sample of prepubertal children affected by FNRFS.
Twenty-six patients (group 1; 16 males, mean age of 5.92 ± 0.84 years) underwent a psychomotor approach therapy program in association with toilet training for 6 months, and the other 26 subjects (group 2; 17 males, mean age of 5.76 ± 0.69) underwent the sole toilet training program for 6 months. During the observational time period (T0) and after 6 months (T1) of both treatments, the patients were evaluated for FNRFS frequency and for the behavioral assessment.
At T0, the FNRFS mean frequency per month for group 1 was 20.115 episodes/month (standard deviation [SD] ± 3.024) and for group 2 was 20.423 (SD ± 1.879) (P = 0.661). At T1 the mean frequency per month was 6.461 (SD ± 1.333) episodes/month and 12.038 (SD ± 1.341), respectively (P < 0.001). Moreover, the delta percent average of the frequency between T0 and T1 was 67.121 ± 8.527 for group 1 and 40.518 ± 9.259 for group 2 (P < 0.001). At T1, a significant improvement in scores on the behavioral scale was identified.
Our preliminary results show the importance of a multidisciplinary approach, and suggest the positive effect of an additional psychomotor approach, as this holds a new and interesting rehabilitative purpose for children in a toilet training program, even if further research is necessary.
... Grealish et al. [29] have shown the effect of foot massage and reflexology on decreasing the anxiety, pain and nausea in patients with cancer. Bishop et al. [4] have proved that reflexology is an effective method of treating encopresis and constipation patients. Christ Stormer has clearly explained the healing effect of reflexology on respiratory, circulatory, and cardiac disorders. ...
Analysis of heart rate variation (HRV) has become a popular non-invasive tool for assessing the activities of the autonomic nervous system (ANS). HRV analysis is based on the concept that fast fluctuations may specifically reflect changes of sympathetic and vagal activity. It shows that the structure generating the signal is not simply linear, but also involves non-linear contributions. These signals are essentially non-stationaryandmaycontainindicatorsofcardiachealth.Thisworkisanattemptmadetodoaquantitativestudyontheeffectofreflexology on the heart rate variability (HRV) during reflexologic stimulation. The non-linear parameters are evaluated for this study and the results obtained for 20 subjects are tabulated. © 2004 Elsevier SAS. All rights reserved. Résumé
... 6 A Cochrane review on reflexology 7 did not, however, find sufficient evidence to support its use and highlighted the need for additional research. Subsequent research has provided some evidence of positive effects in the treatment of premenstrual syndrome, 8 diabetes, 9 chronic constipation in children, 10 and pain in rheumatoid arthritis 11 and metastatic cancer. 12 Only three studies have been undertaken in multiple sclerosis: one observational 13 and two randomized controlled trials. ...
Objective
To examine the feasibility of delivering reflexology to people moderately to severely affected by multiple sclerosis and to investigate the effect on a range of symptoms.
Methods
A pilot single-blind randomized placebo controlled trial.
Setting
An outpatient multiple sclerosis rehabilitation centre.
Subjects
Twenty people moderately to severely affected by multiple sclerosis were randomized into one of two groups receiving either reflexology or sham reflexology.
Intervention
Each participant received 8 weeks, 1 hour per week of either reflexology or sham reflexology.
Main measures
Primary outcome measure was the Multiple Sclerosis Impact Scale (MSIS29). Secondary measures assessed a range of symptoms at baseline, 8 weeks and 16 weeks.
Results
There were no statistically significant differences between the two groups at either 8 (P = 0.538) or 16 (P = 0.112) weeks for the primary outcome measure; however, both groups demonstrated small improvements from 92.3 (SD 20.9) to 75.6 (SD 3.3) with reflexology, and 91.3 (SD 29.9) to 81.5 (±18.5) with sham reflexology group after 8 weeks of treatment. Small improvements were noted in most of the secondary outcome measures at 8 weeks. There was no difference between the groups at 8 weeks except for bladder function (P = 0.003) and most scores returned to baseline at follow-up.
Conclusions
The results do not support the use of reflexology for symptom relief in a more disabled multiple sclerosis population and are strongly suggestive of a placebo response. This study demonstrates, however, that reflexology can be delivered and is well tolerated by people who are moderately to severely affected by multiple sclerosis.
... Grealish et al. [29] have shown the effect of foot massage and reflexology on decreasing the anxiety, pain and nausea in patients with cancer. Bishop et al. [4] have proved that reflexology is an effective method of treating encopresis and constipation patients. Christ Stormer has clearly explained the healing effect of reflexology on respiratory, circulatory, and cardiac disorders. ...
Analysis of heart rate variation (HRV) has become a popular non-invasive tool for assessing the activities of the autonomic nervous system (ANS). HRV analysis is based on the concept that fast fluctuations may specifically reflect changes of sympathetic and vagal activity. It shows that the structure generating the signal is not simply linear, but also involves non-linear contributions. These signals are essentially non-stationary and may contain indicators of cardiac health. This work is an attempt made to do a quantitative study on the effect of reflexology on the heart rate variability (HRV) during reflexologic stimulation. The non-linear parameters are evaluated for this study and the results obtained for 20 subjects are tabulated.RésuméL'analyse de la variation de fréquence cardiaque (HRV) est devenue un outil non invasif très répandu pour évaluer les activités du système nerveux autonome. L'intérêt de la HRV réside dans le fait que les fluctuations rapides peuvent spécifiquement refléter des changements d'activité des systèmes sympathique et vagal. Elle prouve que la structure produisant du signal n'est pas simplement linéaire et met en jeu des fonctionnements non-linéaires. Les signaux sont essentiellement non stationnaires et peuvent refléter des dysfonctionnements cardiaques. Ce travail tente de faire une étude quantitative de l'effet des stimulations réflexologiques sur la variabilité de la HRV. Les paramètres non linéaires sont évalués dans cette étude et les résultats obtenus pour 20 sujets sont présentés.
... Die konservative Therapie der chronischen Obstipation ist in bis zu 70% der betroffenen Kinder erfolgreich. Der initialen rektalen Darmentleerung ("disimpaction") folgt die konservative diätetische Langzeittherapie [1,2]. ...
Chronic constipation in childhood results from (1) psychological/behavioural causes, (2) functional or organic gastrointestinal outlet obstruction, or (3) slowing of transit within the colon. Functional chronic constipation is treated by a complex conservative bowel management. Constipation refractory to routine medical treatment reveals, in a significant number of cases, organic causes. Histology of bowel biopsies is essential for the preoperative diagnosis of chronic constipation. Defective innervated bowel segments require surgical treatment. Intraoperative histological staining of bowel biopsies allows proper resection of aganglionic or dysganglionic bowel. This contribution describes the interdisciplinary, clinicopathological interactions involving children with chronic constipation.
Context: Constipation is a prevalent symptom of gastrointestinal disorders, which has an annoying impact on health and quality of life. On the other hand, reflexology is a popular type of complementary and alternative medicine in medical practices. Objectives: The present study aimed to assess the effect of foot reflexology on constipation symptoms. Methods: Nine databases were systematically searched to detect relevant Randomized Clinical Trials. The current used the Cochrane Risk of Bias tool to evaluate the methodological quality of the included articles. The primary outcome was the improvement of constipation symptoms. The Standardized Mean Difference (SMD) was measured, and random effects were reported instead of the fixed effects due to the high heterogeneity. Results: Out of the 693 articles retrieved from the databases and eight additional records identified through other sources, 496 titles, 48 abstracts, and 16 full-texts were reviewed, and 11 articles were included in this study, out of which nine articles entered the meta-analysis. The findings of the meta-analysis indicated that foot reflexology had a significant effect on the constipation score (SMD:-0.82; 95% CI:-1.47 to-0.17; P value = 0.0001; I 2 = 93%) Conclusions: Foot reflexology can effectively improve constipation symptoms; however, clinical trials with better designs are recommended .
Reflexology in Pregnancy and Childbirth is a definitive text on the safe and appropriate use of reflex zone therapy in pregnancy, labour and the puerperium, focusing on evidence-based practice, professional accountability and application of a comprehensive knowledge of the therapy related to reproductive physiology. Denise Tiran, an experienced midwife, reflex zone therapist, university lecturer and Director of Expectancy - the Expectant Parents' Complementary Therapies Consultancy - has an international reputation in the field of maternity complementary therapies, has researched and written extensively on reflexology, and has treated nearly 5000 pregnant women with structural reflex zone therapy. KEY FEATURES Case histories to ease application of theory to practice Charts, tables and diagrams are used throughout for ease of learning Includes a section on conception, infertility and sub-fertility Covers legalities and ethical issues.
Whether you initiate alternative therapies for children, or simply need to respond when asked for information or advice, it's crucial to have the most current, evidence-based information so that you can safely and effectively integrate CAM therapies with conventional treatment. This innovative and reliable reference is the ideal resource to have at hand. With its focus on integrating conventional medicine with the best complementary therapies for children, it familiarizes you with the scientific evidence and rationales for various CAM therapies, and clearly describes how to use them, in conjunction with conventional medicine. You'll find the information you need to distinguish among those therapies with good evidence, those that are safe but not yet proven to be effective, and those contraindicated for certain conditions. Covers a wide range of complementary and alternative therapies, focusing on those most often utilized with children: mind-body approaches (hypnosis, mind/body, probiotics, spirituality); manual therapies (chiropractic, massage, osteopathy, psychological); lifestyle approaches (nutrition, Qigong); alternative systems (homeopathy, naturopathy); energy medicine (acupuncture, aromatherapy, herbal, laser, magnets); and biological agents (Chinese and Western herbs and probiotics). 57 of the most common pediatric conditions are comprehensively discussed, first with a focus on conventional diagnostic and treatment information, then with authoritative information on the most effective and evidence-based CAM therapies available for treatment of the condition. Presents an integrative approach, combining conventional and alternative therapies. Helps you answer questions relevant to today's patients, such as giving echinacea for a cold, the use of acupuncture to treat ADHD, and which alternative therapies may be used to avoid side effects of conventional medication.
Background
Ao-dake-humi is a traditional Japanese bamboo foot stimulator consisting of a half-pipe-shaped step made of bamboo used to stimulate the foot by stepping on it, and is commonly used to promote general health among the elderly in Japan. However, its efficacy has not been reported in the scientific literature. This study was performed to investigate the role of ao-dake-humi focusing on lower urinary tract symptoms (LUTS), constipation, and hypersensitivity to cold (HC). Methods
Participants with LUTS, constipation, or HC were enrolled in this study. Ao-dake-humi was used twice a day for 28 days. Before and 28 days after starting ao-dake-humi use, international prostate symptom score (IPSS), quality-of-life (QoL) score, and overactive bladder symptom score (OABSS) were measured to evaluate the efficacy of ao-dake-humi on LUTS. To evaluate the objective efficacy of ao-dake-humi on LUTS, a frequency-volume chart (FVC) was plotted in LUTS patients for 3 days. A visual analogue scale (VAS) was used to evaluate the efficacy of ao-dake-humi on constipation (VAS-constipation) and HC (VAS-HC) in the participants with constipation or HC. ResultsA total of 24 participants were enrolled in this study. Twenty-one participants had LUTS, 11 had constipation, and 17 participants had HC. IPSS, especially storage-subscore, QoL score and OABSS, decreased significantly after use of ao-dake-humi. The use of ao-dake-humi increased maximal bladder capacity, resulting in a significant decrease in urinary frequency as determined from the FVC. In accordance with the results of VAS-constipation and VAS-HC, both constipation and HC were significantly relieved after ao-dake-humi use. Conclusion
The results of this prospective pilot study indicated that ao-dake-humi is safe and has therapeutic efficacy in cases of LUTS, constipation and HC. The possibility of using ao-dake-humi as physical neuromodulation therapy was shown in the management of LUTS, constipation and HC. Trial registrationUMIN000019333 (UMIN-CTR, Registered October-15-2015) retrospectively registered.
Complementary and alternative medicine (CAM) is frequently used by pediatric gastroenterology patients with a 1-year prevalence of use of 40 %. CAM treatments are especially popular in children with a low perceived effect of conventional treatment, which is often the case in motility and sensory disorders. This chapter discusses complementary treatment options for those disorders in which they are used fairly often: infantile colic’s, gastroesophageal reflux, functional abdominal pain and irritable bowel syndrome, and constipation. Since a wide range of CAM treatments exist and there is a dearth of good quality of evidence on safety and efficacy of these treatments in children, only those treatments that have been studied best and/or are being used most, including herbs, acupuncture, homeopathy, hypnotherapy, and manual-based therapies, are being discussed.
Complementary and alternative medicine (CAM) is frequently used by pediatric gastroenterology patients with a 1-year prevalence of use of 40 %. CAM treatments are especially popular in children with a low perceived effect of conventional treatment, which is often the case in motility and sensory disorders. This chapter discusses complementary treatment options for those disorders in which they are used fairly often: infantile colic’s, gastro-esophageal reflux, functional abdominal pain and irritable bowel syndrome, and constipation. Since a wide range of CAM treatments exists and there is a dearth of good quality of evidence on safety and efficacy of these treatments in children, only those treatments that have been studied best and/or are being used most, including herbs, acupuncture, homeopathy, hypnotherapy, and manual-based therapies are being discussed.
Gaye Kyle reviews the appropriate use of pharmacological interventions for the management of constipation and considers some alternatives
Die chronische Obstipation im Kindesalter ist in 95% der Fälle funktionell und wird durch ein komplexes konservatives Therapiemanagement versorgt. Eine therapierefraktäre chronische Obstipation weist auf organische Ursachen hin. Die pathologisch-histologische Diagnostik von Darmwandbiopsien ist essenziell für die Diagnosestellung organisch bedingter chronischer Obstipationen. Sie dient in erster Linie dem Ausschluss einer organisch manifesten Innervationsstörung. Intestinale Innervationsstörungen erfordern in der Regel eine chirurgische Therapie. Dabei gewährleistet die intraoperative Schnellschnittdiagnostik eine pathologisch-histologische Beurteilung der Präparate mit anschließender Festlegung der Resektionsgrenzen am fehlinnervierten Darm. Diese Arbeit beschreibt die interdisziplinäre klinisch-pathologische Interaktion bei Kindern mit chronischer Obstipation.
Although effective in faecal incontinence (FI), sacral nerve stimulation (SNS) is expensive and requires two procedures. It carries a small risk of infection and electrode migration. Transcutaneous SNS is non-invasive and cheap. Two small studies have reported the results when applied to segments S3 but there is no information on its effectiveness when applied to the whole sacral area.
A pilot study was carried out of self-administered transcutaneous SNS given over a four week period for 12 hours a day. A two week bowel diary was kept for the final two weeks and compared to baseline. Patients were assessed using the St Mark's incontinence score, a visual analogue scale assessing satisfaction with bowel habit, the Rockwood FI QOL score and SF-36 QOL score.
Of ten patients were recruited, two achieved complete continence. There was a statistically significant reduction in the median (IQR) frequency of incontinent episodes per week from 9.5 (7.5) to 3 (7.38) (p=0.03), and in the median frequency of defecation per week from 25.5 (19.5) to 14.5 (14.9) (p=0.007). There was a statistically significant improvement in the median ability to defer defecation from 1(1.25) to 4.5 (4.5) minutes (p=0.02). There was also a statistically significant improvement in the St Marks incontinence score from 20 (5.25) to 14.5 (8.0) (p= 0.01) and in the bowel habit satisfaction visual analogue scale from 8.5 (20) to 45 (33) (p= 0.008). There was no change in the Rockwood FI QOL or SF-36 QOL scores. No complications were reported.
Transcutaneous SNS appears to be an effective and safe treatment for FI. Larger controlled studies are needed to explore this further. This article is protected by copyright. All rights reserved.
Foot reflexology is a technique based on the treatment of zones on the feet that correspond to different body parts.
Encopresis is an elimination disorder that involves symptoms of fecal incontinence in children. It affects an estimated 1.5% to 7.5% of children ages 6 to 12 and accounts for approximately 3% to 6% of psychiatric referrals. The etiology of encopresis is thought to be related to physiologic problems such as constipation; however, it is also a psychiatric diagnosis and anecdotally may have some association with psychiatric problems. Publications on this association and publications directed toward psychiatric nurses are limited. Encopresis is typically treated with nutritional and medical management along with behavioral modification. Psychiatric nurses working with patients who have encopresis in inpatient settings will have unique concerns and challenges. This article gives an overview of published literature from the past 10 years on the etiology and treatment of encopresis. Specific suggestions for inpatient psychiatric nurses based on published literature and the author's professional experience are provided.
The paper introduces haptic medicine--healthcare based on loving touch for healing and preventing disease. We describe the effects of loving touch (a square inch of our skin has over 1000 nerves) on the body, brain and mind. We describe two web-based health education and media projects. The first, HYPERLINK "http://www.21stcenturymed.org" www.21stcenturymed.org is a place for health practitioners to start learning about touch and resources. The second project, Humans Without Borders, is a multi-lingual self help education website for everyday people. Teaching materials for these projects are based on our previous work with a form of haptic medicine known as psychophysiophilosophy with patients at Stanford Hospital, Kaiser Permanente and Lucille Packard Children's Hospital. We describe psychophysiophilosophy, relate motherly love to recent discoveries in neurosciences and give hints on ways to increase motherly love in each of us. We present a plan for moving into the future by re-introducing haptic medicine into our daily lives through self-help and as an adjunct for current physician practice. There is an exercise in self-help for the reader and an appendix of recent clinical research with profound benefits on the use of human touch for over 40 conditions.
The presence of high-amplitude propagating contractions (HAPCs) has been identified as a marker of colonic neuromuscular integrity. The physiologic mechanisms of HAPCs initiation have yet to be determined. Distention secondary to colonic filling has been hypothesized as physiologic initiator. The aim of this study was to study the effect of intraluminal balloon distention in the colon of children with defecatory disorders. Colonic manometry was performed with a polyethylene balloon situated at the proximal end of the catheter, which was placed in the most proximal colonic segment reached during colonoscopy. A stepwise pressure controlled distention of the balloon was performed using barostat computer (10-50 mmHg). Propagated contractions were defined as those that migrated over at least three recording sites. They were divided into HAPCs, amplitude >60 mmHg and low-amplitude propagating contractions (LAPCs), amplitude <60 mmHg. Children with spontaneous HAPCs or HAPCs after bisacodyl provocation were considered to have normal motility. Twenty children completed the study. Among the 14 children with normal colonic motility, balloon distention elicited HAPCs in four and LAPCs in 10 children. No HAPC were elicited in six children with abnormal motility and LAPCs were seen in four of them. The balloon-induced propagated contractions had similar characteristics as those occurring spontaneously and after bisacodyl provocation but the pressure needed to elicit them and their amplitude was inconsistent. These findings suggest that intraluminal distention can trigger propagated contractions in children. This mechanism of action for induction of propagated contractions is not as consistent as the motor response found in response to bisacodyl administration.
Constipation is a common and distressing pediatric problem. Even if prevalence of this disorder has increased, treatment of constipation in children is still largely based on clinical experience rather than on evidence-based studies. The currently recommended treatment includes education, disimpaction, and maintenance therapy, consisting of dietary changes, behavioral modification, and use of laxatives. Among osmotic agents, polyethylene glycol solutions appear to be the first-line drug to use in pediatrics. Although these measures are effective in the majority of children, a sizable proportion needs long-term therapy. Chronicity may significantly interfere with the child's emotional growth and development. Advances in the understanding of the gastrointestinal enteric nervous system and epithelial function have led to the development of new classes of drugs. These include substances that bind to serotonin receptors or are chloride channel activators. Further studies are needed to assess the benefits and the risks of these new drugs.
participate and interact with established investigators in the field.Finally, the symposium intendedto developa research agenda for collaborative studies to define the pathophy- siology and treatment strategies for childhood FAP. During the symposium the biopsychosocial model was endorsed to provide a framework to integrate the bio- logical and psychosocial components of FGID. The biopsychosocial model assumes that the individual genetic background and early life experiences influence the biological and psychosocial predisposition to symp- tom development in response to a variety of physiological or noxious stimuli later in life. This response is affected by physical, environmental, and social exposures that influence the patient's attitude toward illness. The first module of the symposium discussed the basic and pathophysiological mechanisms underlying FGID, including the role of early life events, genetics, and environment. Given that the biopsychosocial model has been adopted by investigators dealing with non-GI functional disorders, such as fibromyalgia, autonomic dysfunction, and migraine, experts from non-GI disci- plines were asked to share their experiences in the second module of the symposium. The absence of a consistent biological marker in FGID has led to the development of symptom-based criteria to diagnose these disorders. The third module was dedicated to discussion of the Rome criteria (7-9). Finally, the last didactic module discussed medical, behavioural, and complementary treatment strategies for pediatric FGIDs. The end of the symposium was dedicated to the discus- sion of a research agenda and the creation of a pediatric multicenter consortium for the study of FGIDs, and brought together representatives from the National Institutes of Health, industry, and many interested pediatric gastroen-
To estimate the total health care utilization and costs for children with constipation in the United States.
We analyzed data from 2 consecutive years (2003 and 2004) of the Medical Expenditure Panel Survey (MEPS), a nationally representative household survey. We identified children who either had been reported as constipated by their parents or had received a prescription for laxatives in a given year. Outcome measures were service utilization and expenditures.
The MEPS database included a total of 21 778 children age 0 to 18 years, representing 158 million children nationally. An estimated 1.7 million US children (1.1%) reported constipation in the 2-year period. No differences with respect to age, sex, race, and socioeconomic status were found between the children with constipation and those without constipation. The children with constipation used more health services than children without constipation, resulting in significantly higher costs: 1099/year. This amounts to an additional cost for children with constipation of $3.9 billion/year.
This study demonstrates that childhood constipation has a significant impact on the use and cost of medical care services. The estimated cost per year is 3 times than that in children without constipation, which likely is an underestimate of the actual burden of childhood constipation.
This article considers briefly how and why complementary and alternative medicine has developed in children's care during the last 10 years. Some of the therapies utilised by children are discussed, similarities and differences to trends in CAM for adults highlighted and a potential role for CAM in children's care in the future, suggested.
Constipation affects the quality of life of many 'at risk' groups of people. Laxatives are the dominant management strategy whose long-term use is ineffective and very costly to the NHS prescription bill and in the use of health staff resources. The development of a user-friendly, evidence-based clinical guideline (The effective management of constipation in primary care) has the potential to change the present situation by providing healthcare practitioners with an aide-mémoire to assist clinical reasoning, in order to re-evaluate current practice and suggest combined alternative treatment strategies. Early indications of use of the guideline suggest holistic individualised bowel management programmes can significantly reduce laxative use and nursing interventions and lead to improved quality of life.
Constipation is an unpleasant and distressing symptom that many palliative care patients may experience, often having a profound effect on their quality of life. The many management options available reflect the multifactorial nature of constipation. The article explores the complexity of constipation in palliative care and highlights the challenge of managing opioid-induced constipation. Advances in the pharmacological and non-pharmacological management of constipation are reviewed and discussed in the light of relevant research. Further discussion includes definitions, incidence and causes of constipation in palliative care.
Constipation is a worldwide problem that affects many children. Treatment of constipation is largely based on clinical experience rather than on evidence-based controlled clinical trials. Stool softeners and cathartic agents in combination with behavioral interventions constitute the programs most commonly used to facilitate painless and frequent defecation. Long-term treatment is needed for most patients, and approximately 30% of children beyond puberty continue to struggle with symptoms of constipation, such as infrequent, painful evacuation of stools and fecal incontinence. Not surprisingly, chronicity of these bowel complaints may cause significant interference with the child's emotional growth and development. Development of new therapeutic strategies is necessary in order to treat these challenging patients more effectively. This review provides an overview of novel and alternative therapies, such as new drugs, surgery, and probiotics, that are being proposed for the treatment of childhood chronic constipation.
Constipation is a common symptom throughout all ages in the pediatric population, both sexes, and all educational and socioeconomic levels. It is estimated that 12% to 30% of the general population suffers from functional constipation. A practical overview of pathogenic mechanisms contributing to constipation is presented, with emphasis on evaluation and management options available to the treating practitioner. The evaluation of constipation requires careful history taking and interpretation. Diagnostic tests such as manometry and colonic scintigraphy are reserved for those severely affected. Constipation can be challenging to treat, especially if pain and discomfort are predominant features. Therapy requires early recognition of the problem; support by physicians and family members; identification and explanation of contributing factors; and the providing of medications, including osmotic and/or stimulant laxatives. When constipation becomes refractory to standard medical treatment, more novel considerations may include probiotics, botulinum toxin, mind-body interventions, electrical stimulation of the intestine, and surgery.
Constipation and encopresis (fecal soiling) are common childhood disorders that may lead to significant functional impairment. The etiology and course of constipation and encopresis are increasingly conceptualized from a broad biopsychosocial perspective, and therefore a holistic approach to assessment and treatment is indicated. Many children experience symptoms of chronic constipation and/or encopresis that are only partially responsive to conventional medical therapy. Complementary/alternative therapies can often help in the treatment of constipation/encopresis and are well accepted by patients and families.
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